Organization
VEENAKUMAR
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. VEENA KUMAR (MANAGER)
(904) 619-4204
Entity
Organization
Contact information
Practice address
12152 BASALT DR S, JACKSONVILLE, FL 32246-0680
(904) 619-4204
Mailing address
12152 BASALT DR S, JACKSONVILLE, FL 32246-0680
(904) 619-4204
Taxonomy
Speciality
Code
Description
License number
State
251T00000X
PACE Provider Organization
Primary
W268696
FL
Other
Enumeration date
10/08/2016
Last updated
10/08/2016
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